Intubation tubes

ABSTRACT

An intubation, endotracheal, or other tube having a tubular portion provided with a bulbous cuff encirclingly disposed on its distal end. The cuff is formed from an easily compressible or distortable material which constantly seeks to revert to its original shape, yet, when distorted, exerts pressure of small magnitude on the distorting object. The cuff sealingwise engages the walls of a patient&#39;&#39;s encircling tracheal lining. The cuff of one embodiment is reduced in diameter at its center for accommodation of the patient&#39;&#39;s vocal cords.

United States Patent Doherty 1 1 Feb. 1, 1972 [54] INTUBATION TUBES [72] inventor: George 0; Doherty, 2301 River Road,

Missoula, Mont. 59801 [22] Filed: May 18,1970

[2]] Appl.No.: 37,462

Related U.S. Appllcatlon Data [631 Continuation of Scr. No. 628,593, Apr. 5, 1967, abandoncd.

[52] US. Cl ..l28/35l [51] Int. Cl. ..A61m 25/00 [58] Field oISearch ..l28/145.5l45.8,

[56] References Cited UNITED STATES PATENTS 703,107 6/1902 Wood ..l28l239 2,548,602 4/1951 Greenburg 128/344 2,898,913 8/1959 Ritter et a1 ..128/325 3,087,493 4/1963 Schosson... ..,.l28/351 3,095,877 7/1963 Rowan.... ....128/325 3,205,890 9/1965 Dritz ....128/35l 3,407,817 10/1968 Galleher, .lr. ..128/351 3,411,506 11/1968 Velasco 128/349 Primary Examiner-Charlcs F. Rosenbaum Attorney-John D. Pope, Ill

[5 '7 I ABSTRACT An intuhution, endotruchcal, or other tuhc having u tubular portion provided with a bulbous cull encirclingly disposed on its distal end. The cuff is formed from an easily compressible or distortable material which constantly seeks to revert to its original shape, yet, when distorted, exerts pressure of small magnitude on the distorting object. The cuff sealingwise engages the walls of a patients encircling tracheal lining. The cuff of one embodiment is reduced in diameter at its center for accommodation of the patient's vocal cords.

13 Claims, 7 Drawing Figures PATENIED FEB 1m SHEET 1 OF 2 FIG FIG.

l-III ll l lllllll INVENTOR GEORGE O. D'OHERTY FIG. 4 M&%

ATTORNEY FIG. 1

PATENTEDFEB me 3.638.655

SHEEI 2 BF 2 mvemog GEORGE O. DOHERTY M WW ATTORNEY INTUBATION TUBES This application is a streamline continuation of application Ser. No. 628,593, filed Apr. 5, I967, now abandoned.

During surgical procedures it is often desirable to maintain complete control over the patients breathing. I-Ieretofore, this has been accomplished by administering oxygen and anesthetics to the patient through an endotracheal tube inserted through the patient's mouth and larynx and into the vestibular portion of the trachea. These tubes externally carry inflatable rubber cuffs which are inflated once the cuff has passed the larynx so as to form a fluidtight seal between the encircling tracheal lining and the outer surface of the tube. In this manner, any suitable gaseous mixture can be passed into the patients lungs.

The embracing inflatable cuffs, however, have not proved entirely satisfactory for the foregoing purpose. In the first place, some remotely located means must be provided for inflating the cuff once it reaches the vestibular portion of the trachea and such means usually involve a small flexible inflation tube which extends loosely along the side of the larger cuff-carrying tube interconnecting the cuff thereon with a small syringe-type bulb located beyond the patients mouth. These small tubes are a nuisance and often interfere with the conduct of the operation. Moreover, during emplacement, they obstruct the anesthesiologists view and often become twisted and tangled. On the other hand, if the inflation tube is located internally ofthe endotracheal tube, it can interfere with the insertion of instruments through the latter tube. Secondly, conventional'endotracheal tubes, because of the nature of their construction, generally cannot be manufactured at a cost which would permit their use on a disposable basis. Consequently, they are reused after sterilization, but because the cuffs are constructed of rubber they cannot be sterilized by steam or other high-temperature methods. This increases the possibility of transferring infections from one patient to another.

Among the several objects of the present invention may be noted the provision of an intubation tube which can be inserted into an enclosed channellike passage so as to form a fluidtight seal therewith; the provision of an endotracheal tube having a cuff which is compressed within the trachea was to form a fluidtight seal with the encircling tracheal lining; the provision of an endotracheal tube which is simple in construction and economical to manufacture; the provision of an endotracheal tube which is completely disposable; the provision of an endotracheal tube which is not easily dislodged through inadvertence once emplaced; and the provision of an endotracheal tube which creates comparatively little irritation when placed within a patients trachea. Other objects and features will be in part apparent and in part pointed out hereinafter.

The invention accordingly comprises the constructions hereinafter described, the scope of the invention being indicated in the following claims.

In the accompanying drawings, in which several of various possible embodiments of the invention are illustrated,

FIG. I is an elevational view of an endotracheal tube constructed in accordance with and embodying the present invention;

FIG. 2 is a sectional'view taken along line 2-2 of FIG. 1;

FIG. 3 is an elevational view of the endotracheal tube showing it emplaced within the trachea of a patient illustrated in phantom;

FIG. 4 is an elevational view of a modified form of endotracheal tube formingpartof the'present invention;

FIG. 5 is a sectional view taken along lineS-S of FIG. 4;

FlG.--6 is a fragmentary elevational view of another form of endotracheal tube forming part of the present invention;.and

FIG. 7 is-a sectional view of the endotracheal tube of FIG. 6 emplaced within the trachea ofa patient, the patient being illustrated in phantom.

Corresponding rcferencecharacters indicate corresponding parts throughout the several views of thedrawings.

Referring now to the drawings, 2 designates an endotracheal tube including a tubular portion 4 having a distal end 6 and a proximal end 8. Tubular portion 4 is preferably formed from a flexible relatively soft synthetic or natural material. Embracing tubular portion 4 at its distal end 6 is a bulbous cuff 10 having a substantially circular transverse cross-sectional shape and a somewhat elongated or elliptical longitudinal cross-sectional configuration. Cuff 10 is provided with a central bore 12, the walls of which snugly embrace and are preferably adhesively secured to the external surface of tubular portion 4.

Cuff 10 is formed from a spongy rubber, plastic, or other natural or synthetic material having a trabeculated or cellular consistency. The material is easily compressed, but once compressed seeks to revert to its original configuration. The exact choice of material is not critical, the significant factor being that it compresses or distorts under forces of relatively small magnitude, but when these forces are removed it readily reverts to its original shape. This cuff material can be formed or molded in any conventional manner, and, if desired, it can be provided with a smooth cavity-free outer surface. This can be accomplished by the application of heat, by coating with a plastic or latex, or by actually using a covering of thin latex or thin plastic within which the foamy or spongy material is flowed, extruded, or otherwise introduced.

Referring now to FIG. 3, endotracheal tube 2 is emplaced merely by inserting its distal end into the patients mouth 14 and larynx l6 and insinuating cuff 10 through the narrow laryngeal orifice formed by the vocal cords 18. The surface of cuff 10 is first coated with a suitable lubricant such as xylocaine jelly which has anesthetic properties to lessen irritation upon placement. Distal end 6 is then passed through the patients mouth 14 and larynx 16 until cuff 10 engages vocal cords 18 of larynx l6, whereupon the anesthesiologist, by manipulating proximal end 8, urges tube 2 still further inwardly. This causes cuff 10 to contract or deform to the crosssectional shape of the patients laryngeal orifice. Tube 2 is urged further inwardly, causing cuff 10 to glide past vocal cords 18. Once beyond vocal cords l8, cuff 10 reexpands, seeking to revert to its original size within the vestibular portion 20 of the patient's trachea 22 and in so doing engages the encircling tracheal lining, assuming the cross-sectional shape thereof and forming a fluidtight seal therewith. Inasmuch as the foamed or spongy material from which cuff 10 is formed deforms under forces of small magnitude, the restricted portion of the larynx 16 is not in anyway injured or subject to significant irritation. Similarly, once in vestibular portion 20 of trachea 22, cuff l0 exerts a slight substantially uniform pressure on the encircling tracheal lining, forming an adequate sealtherewith, but does not in anyway annoy it.

Endotracheal tube 2, including tubular portion 4 and bulbous cuff 10 can be produced by means of an inexpensive manufacturing operation requiring little skilled labor or expensive production machinery. Consequently, it can be sold at a price which would justify its use on a disposable basis. Nevertheless, it can be sterilized in a manner similar to conventional inflatable cuff-type endotracheal tubesand, therefore, can be used for more than one operation or other surgical procedure.

As will be seen from FIGS. 4 and 5, it is possible to provide a modified endotracheal tube 30 also including a tubular portion 32 and a bulbous cuff 34, the latter of which can be formed from any of the materials previously discussed in conjunction with cuff 10. Cuff 34, however, is provided with a longitudinally extending bore 36 located offcenter with respect to the outer periphery of cuff 34 so that when the distal end of tubular portion 32 is fitted into bore 36 and adhesively secured to the walls thereof, cuff 34 will be disposed eccentrically on tubular portion 32. At the opposite or proximal endof tubular portion 32, a stripe 38 or other suitable indicia is inscribed to indicate the circumferential portion on tubular portion 32 where the outward radial protuberance of cuff 34 is smallest.

Endotracheal tube 30 is manipulated through the patients larynx and into the trachea in a manner similar to endotracheal tube 2. inasmuch as cuff 34 is located eccentrically on tubular portion 32, the anesthesiologist can rotate tubular portion 32 so that the circumferential portion of cuff 34 having the smallest radial projection with respect to tubular portion 32 is presented along the anesthesiologists line of sight. The actual location of this portion can be readily ascertained by observing stripe 38. Consequently, tubular portion 32 can be rotated to bring cuff 34 into a position wherein cuff 34 and tubular portion 32 are held in such a manner within the patients larynx that the visual obstruction caused thereby is reduced to an absolute minimum. This construction affords the anesthesiologist proper inspection of cuff 34 and tubular portion 32 as well as the patient's larynx as cuff 34 is manipulated through the latter.

The eccentric disposition of cuff 34 necessarily guides the distal end of tubular portion 32 into an eccentrically located position within the patients trachea. This is of no consequence from the standpoint of administering anesthetics. However, once emplaced, endotracheal tube 30 can be rotated so that its distal end is disposed offcenter in any desired direction. Accordingly, instruments such as probing suction catheters which are generally passed through endotracheal tubes can more easily be directed to whatever quarter the operator desires to perform more intensive work.

Referring now to FIGS. 6 and 7, it is possible to provide another modified endotracheal tube 40 also including a tubular portion 42 and a bulbous cuff 44, the latter of which is formed from any of the resilient materials previously discussed in conjunction with cuff l0. Cuff 44, however, possesses a diametrally reduced center portion 46 defined by gently sloping surfaces 48 which lend an hourglass appearance thereto. Cuff 44 is divided into forward and rear cuff portions 50, 52, by reduced center portion 46.

Endotracheal tube 40 is emplaced by smearing cuff 44 with a suitable lubricant and then advancing the distal end of tubular portion 42 through the patients mouth 14 and larynx l6. Eventually forward cuff portion 50 will encounter the restricted laryngeal orifice formed by vocal cords 18. A slight forward or inward thrust will, however, compress forward cuff portion 50 allowing it to glide past vocal cords 18 and into the vestibular portion of trachea 22. Rear cuff portion 52, on the other hand, remains proximal to vocal cords 18 so that gently sloping surfaces 48 are embraced by vocal cords 18 which form the restricted laryngeal orifice. Thus, diametrally reduced portion 46 accommodates the patients vocal cords 18 so that irritation is reduced to an absolute minimum during the course of the operation. Nevertheless, a fluidtight seal is formed by the snugness of the fit above and below the vocal cords 18 as well as in the area of vocal cords l8 themselves. Consequently, a compressive, yet contoured, fit is achieved through the use of a suitable resilient material and this contoured fit greatly aids in preventing endotracheal tube 40 from becoming dislodged.

Whereas the cuffs of conventional endotracheal tubes are passed through the larynx in a deflated condition and are subsequently inflated in the trachea by means of suitable inflating devices, cuffs 10, 34, and 44 of tubes 2, 30, and 40, respectively, are merely eased through and compressed by the larynx itself. Once beyond the larynx, they reexpand by virtue of their own natural resiliency and thereby engage the encircling tracheal lining forming a fluidtight seal therewith. Consequently, no remotely located inflating devices are necessary to enable cuffs 10, 34, or 44 to achieve a proper seal.

It should be understood that endotracheal tubes 2, 30, 40, can be employed in numerous other situations where it is desired to temporarily seal a tube within an enclosed channel, such as intubation of other body canals, joining two tubes of unequal diametral size, etc.

In view of the above, it will be seen that the several objects of the invention are achieved and other advantageous results attained.

As various changes could be made in the above constructions without departing from the scope of the invention, it is intended that all matter contained in the above description or shown in the accompanying drawings shall be interpreted as illustrative and not in a limiting sense.

What is claimed is:

1. An intubation tube for establishing communication through and for sealingwise engaging a body canal; said intubation tube comprising a tubular portion adapted to telescopically fit within said body canal; a bulbous cuff mounted on and encircling said tubular portion; said cuff normally having a bulbous shape and being formed from an elastic compressible material which when compressed or distorted seeks to revert to its original configuration; said cuff having an outer skin which is smooth and substantially cavity free so as to prevent the passage of air through said cuff; said cuff being free from communication with means for inflating it; and said cuff being larger than said body canal so that when confined within said canal it yieldably distorts to the cross-sectional size and shape of said canal, thereby forming a fluidtight seal between said tubular portion and said canal.

2. An intubation tube according to claim 1 wherein said skin is a thin covering surrounding said cuff.

3. An intubation tube according to claim 1 wherein said skin is formed by the application of heat to the outer surface of said cufi.

4. An intubation tube according to claim 1 wherein said tubular portion includes at least one end which extends from said bulbous cuff, said end being free for grasping and manipulation of said tube.

5. An incubation tube according to claim I in which the cuff is formed from a cellular material.

6. An intubation tube according to claim 1 in which the cuff is formed from a trabeculated material.

7. An intubation tube according to claim 1 in which the cuff possesses a spongy consistency.

8. An intubation tube according to claim 1 for use as an endotracheal tube wherein the cuff is substantially circular in transverse cross-sectional configuration concentric about the axis of the tubular portion and of a diameter sufficient in size to sealingwise engage a patients tracheal lining caudad to the larynx, and wherein the cufi is further elongated in longitudinal cross-sectional configuration.

9. An intubation tube according to claim 1 for use as an endotracheal tube wherein the cuff is adhesively secured to the external surface of the tubular portion.

10. An intubation tube according to claim 1 for use as an endotracheal tube wherein said tubular portion extends through a longitudinally extending bore in said cufi, said bore being located offcenter with respect to the outer periphery of said cuff, said cuff being sized to engage a patients tracheal lining caudad to the larynx; said offcenter location of said bore permitting visual inspection of said cuff, said tubular portion, and said larynx during insertion of said endotracheal tube into a patient s trachea.

11. An intubation tube according to claim I for use as an endotracheal tube wherein said cuff is provided intermediate its ends with a diametrally reduced center portion which divides said cuff into forward and rear cuff portions, said center portion being sized to accommodate the patients larynx; at least one of said forward and rear cuff portions being larger than the patients trachea so that it yieldably distorts to the cross-sectional size and shape of said trachea, the elasticity of said one cuff portion causing it to expand outwardly against said trachea to form a fluidtight seal therewith.

12. An intubation tube according to claim 11 wherein both of said forward and rear cuff portions are larger than the patients trachea so as to fit snugly therein, thereby providing a fluidtight seal above and below the patients larynx when said center portion is positioned within said trachea adjacent said larynx.

13. An intubation tube for establishing communication through and for sealingwise engaging a body canal; said intudiameters at its ends, and normally having a rounded contour tapering toward said ends from said enlarged diameter; said cuff being free from communication with means for inflating it; and said enlarged diameter being larger than said body canal so that when said cuff is within said canal it yieldably distorts to the cross-sectional size and shape of said canal. 

1. An intubation tube for establishing communication through and for sealingwise engaging a body canal; said intubation tube comprising a tubular portion adapted to telescopically fit within said body canal; a bulbous cuff mounted on and encircling said tubular portion; said cuff normally having a bulbous shape and being formed from an elastic compressible material which when compressed or distorted seeks to revert to its original configuration; said cuff having an outer skin which is smooth and substantially cavity free so as to prevent the passage of air through said cuff; said cuff being free from communication with means for inflating it; and said cuff being larger than said body canal so that when confined within said canal it yieldably distorts to the cross-sectional size and shape of said canal, thereby forming a fluidtight seal between said tubular portion and said canal.
 2. An intubation tube according to claim 1 wherein said skin is a thin covering surrounding said cuff.
 3. An intubation tube according to claim 1 wherein said skin is formed by the application of heat to the outer surface of said cuff.
 4. An intubation tube according to claim 1 wherein said tubular portion includes at least one end which extends from said bulbous cuff, said end being free for grasping and manipulation of said tube.
 5. An incubation tube according to claim 1 in which the cuff is formed from a cellular material.
 6. An intubation tube according to claim 1 in which the cuff is formed from a trabeculated material.
 7. An intubation tube according to claim 1 in which the cuff possesses a spongy consistency.
 8. An intubation tube according to claim 1 for use as an endotracheal tube wherein the cuff is substantially circular in transverse cross-sectional configuration concentriC about the axis of the tubular portion and of a diameter sufficient in size to sealingwise engage a patient''s tracheal lining caudad to the larynx, and wherein the cuff is further elongated in longitudinal cross-sectional configuration.
 9. An intubation tube according to claim 1 for use as an endotracheal tube wherein the cuff is adhesively secured to the external surface of the tubular portion.
 10. An intubation tube according to claim 1 for use as an endotracheal tube wherein said tubular portion extends through a longitudinally extending bore in said cuff, said bore being located offcenter with respect to the outer periphery of said cuff, said cuff being sized to engage a patient''s tracheal lining caudad to the larynx; said offcenter location of said bore permitting visual inspection of said cuff, said tubular portion, and said larynx during insertion of said endotracheal tube into a patient''s trachea.
 11. An intubation tube according to claim 1 for use as an endotracheal tube wherein said cuff is provided intermediate its ends with a diametrally reduced center portion which divides said cuff into forward and rear cuff portions, said center portion being sized to accommodate the patient''s larynx; at least one of said forward and rear cuff portions being larger than the patient''s trachea so that it yieldably distorts to the cross-sectional size and shape of said trachea, the elasticity of said one cuff portion causing it to expand outwardly against said trachea to form a fluidtight seal therewith.
 12. An intubation tube according to claim 11 wherein both of said forward and rear cuff portions are larger than the patient''s trachea so as to fit snugly therein, thereby providing a fluidtight seal above and below the patient''s larynx when said center portion is positioned within said trachea adjacent said larynx.
 13. An intubation tube for establishing communication through and for sealingwise engaging a body canal; said intubation tube comprising a tubular portion adapted to telescopically fit within said body canal; a bulbous cuff mounted on and encircling said tubular portion; said cuff normally having a bulbous shape and being formed from an elastic compressible material which when compressed or distorted seeks to revert to its original configuration; said cuff being elongated, having an enlarged diameter intermediate its ends, having reduced diameters at its ends, and normally having a rounded contour tapering toward said ends from said enlarged diameter; said cuff being free from communication with means for inflating it; and said enlarged diameter being larger than said body canal so that when said cuff is within said canal it yieldably distorts to the cross-sectional size and shape of said canal. 